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Pelvic pain in pregnancy - NHS

Some women may develop pelvic pain in pregnancy. This is sometimes called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD).

PGP is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis.

Symptoms of PGP

PGP is not harmful to your baby, but it can be painful and make it hard to get around.

Women with PGP may feel pain:

  • over the pubic bone at the front in the centre, roughly level with your hips
  • across 1 or both sides of your lower back
  • in the area between your vagina and anus (perineum)
  • spreading to your thighs

Some women may feel or hear a clicking or grinding in the pelvic area.

The pain can be worse when you're:

  • walking
  • going up or down stairs
  • standing on 1 leg (for example, when you're getting dressed)
  • turning over in bed
  • moving your legs apart (for example, when you get out of a car)

Most women with PGP can have a vaginal birth.

Non-urgent advice: Call your midwife or GP if you have pelvic pain and:

  • it's hard for you to move around
  • it hurts to get out of a car or turn over in bed
  • it's painful going up or down stairs

These can be signs of pregnancy-related pelvic girdle pain.

Treatments for PGP

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort.

You can ask your midwife for a referral to a physiotherapist who specialises in obstetric pelvic joint problems.

Physiotherapy aims to relieve or ease pain, improve muscle function, and improve your pelvic joint position and stability.

This may include:

  • manual therapy to make sure the joints of your pelvis, hip and spine move normally
  • exercises to strengthen your pelvic floor, stomach, back and hip muscles
  • exercises in water
  • advice and suggestions, including positions for labour and birth, looking after your baby and positions for sex
  • pain relief, such as TENS
  • equipment, if necessary, such as crutches or pelvic support belts

These problems tend not to get completely better until the baby is born, but treatment from an experienced practitioner can improve the symptoms during pregnancy.

You can contact the Pelvic Partnership for information and support.

Coping with pelvic pain in pregnancy

Your physiotherapist may recommend a pelvic support belt to help ease your pain, or crutches to help you get around.

It can help to plan your day so you avoid activities that cause you pain. For example, do not go up or down stairs more often than you have to.

The Pelvic, Obstetric & Gynaecological Physiotherapy (POGP) network also offers this advice:

  • be as active as possible within your pain limits, and avoid activities that make the pain worse
  • rest when you can
  • ask your family, friends or partner, if you have one, to help with everyday activities
  • wear flat, supportive shoes
  • sit down to get dressed – for example, do not stand on 1 leg when putting on jeans
  • keep your knees together when getting in and out of the car – a plastic bag on the seat can help you swivel
  • sleep in a comfortable position – for example, on your side with a pillow between your legs
  • try different ways of turning over in bed – for example, turning over with your knees together and squeezing your buttocks
  • take the stairs 1 at a time, or go upstairs backwards or on your bottom
  • if you're using crutches, have a small backpack to carry things in
  • if you want to have sex, consider different positions, such as kneeling on all fours

POGP suggests that you avoid:

  • standing on 1 leg
  • bending and twisting to lift, or carrying a baby on 1 hip
  • crossing your legs
  • sitting on the floor, or sitting twisted
  • sitting or standing for long periods
  • lifting heavy weights, such as shopping bags, wet washing or a toddler
  • vacuuming
  • pushing heavy objects, such as a supermarket trolley
  • carrying anything in only 1 hand (try using a small backpack)

The physiotherapist should be able to provide advice on coping with the emotional impact of living with chronic pain, such as using relaxation techniques. If your pain is causing you considerable distress, then you should let your GP or midwife know. You may require additional treatment.

Download the POGP leaflet Pregnancy-related pelvic girdle pain for mothers-to-be and new mothers.

You can get more information on managing everyday activities with PGP from the Pelvic Partnership.

Labour and birth with pelvic pain

Many women with pelvic pain in pregnancy can have a normal vaginal birth.

Plan ahead and talk about your birth plan with your birth partner and midwife.

Write in your birth plan that you have PGP, so the people supporting you during labour and birth will be aware of your condition.

Think about birth positions that are the most comfortable for you, and write them in your birth plan.

Being in water can take the weight off your joints and allow you to move more easily, so you might want to think about having a water birth. You can discuss this with your midwife. 

Your 'pain-free range of movement'

If you have pain when you open your legs, find out your pain-free range of movement.

To do this, lie on your back or sit on the edge of a chair and open your legs as far as you can without pain.

Your partner or midwife can measure the distance between your knees with a tape measure. This is your pain-free range.

To protect your joints, try not to open your legs wider than this during labour and birth.

This is particularly important if you have an epidural for pain relief in labour, as you won't be feeling the pain that warns you that you're separating your legs too far.

If you have an epidural, make sure your midwife and birth partner are aware of your pain-free range of movement of your legs.

When pushing in the second stage of labour, you may find it beneficial to lie on one side.

This prevents your legs from being separated too much. You can stay in this position for the birth of your baby, if you wish.

Sometimes it might be necessary to open your legs wider than your pain-free range to deliver your baby safely, particularly if you have an assisted delivery (for example, with the vacuum or ventouse).

Even in this case, it's possible to limit the separation of your legs. Make sure your midwife and doctor are aware that you have PGP.

If you go beyond your pain-free range, your physiotherapist should assess you after the birth.

Take extra care until they have assessed and advised you.

Who gets pelvic pain in pregnancy?

It's estimated that PGP affects up to 1 in 5 pregnant women to some degree.

It's not known exactly why pelvic pain affects some women, but it's thought to be linked to a number of issues, including previous damage to the pelvis, pelvic joints moving unevenly, and the weight or position of the baby.

Factors that may make a woman more likely to develop PGP include:

  • a history of lower back or pelvic girdle pain
  • previous injury to the pelvis (for example, from a fall or accident)
  • having PGP in a previous pregnancy
  • a physically demanding job
  • being overweight
  • having a multiple birth pregnancy

healthtalk.org has interviews with women talking about their experiences of pelvic pain in pregnancy.

Read more about coping with common pregnancy problems, including nausea, heartburn, tiredness and constipation.

Find maternity services or physiotherapy services near you.

Community content from HealthUnlocked

Groin pain in pregnancy: Causes, symptoms, and treatment

Groin pain is common during pregnancy, and it often becomes more intense as the pregnancy progresses. Ligament pain and vaginal issues are common causes of groin pain during pregnancy.

Groin pain is not an emergency, and it does not usually indicate a problem with the pregnancy. However, it is important to mention all pregnancy symptoms to a doctor or midwife.

In this article, we outline the causes of groin pain during pregnancy, along with their associated symptoms and treatments. We also provide information on when to see a doctor for this type of pain.

Share on PinterestIt is common for women to experience groin pain during pregnancy.

Below are some of the most common causes of groin pain during pregnancy, alongside explanations of their associated symptoms and treatments.

Symphysis pubis dysfunction

The pubic symphysis is a joint that sits between the left and right pubic bones. During pregnancy, the ligaments and muscles that support the joint relax and stretch to accommodate the growing uterus and fetus. This relaxing and stretching causes the pubic symphysis to become unstable, resulting in symphysis pubis dysfunction (SPD).

SPD can cause the following symptoms, which tend to worsen during the second and third trimesters of pregnancy:

  • clicking in the hips or pelvis
  • muscle spasms or shooting pains in the pelvic area
  • sharp, shooting pains in the vagina, perineum, or rectum
  • electric shock-like sensations in the vagina or groin area
  • pain that radiates from one part of the pelvic area to another

Many women refer to SPD as “lightning crotch” because of the strange electrical sensations they feel. The pain ranges from mild to severe and often gets worse with the following activities:

  • transitioning from sitting to standing
  • climbing stairs
  • carrying heavy objects
Treatment

SPD is not a medical issue but a temporary pain of pregnancy. It does not indicate that there is anything wrong with the pregnant woman or the developing fetus.

For most women, the symptoms of SPD go away shortly after giving birth. In the meantime, gentle hip stretches and exercises may help alleviate the symptoms.

Some women also find relief using the following treatments:

  • acupuncture
  • chiropractic massage
  • application of heat or ice to the pubic region

Round ligament pain

Round ligaments are tough, fibrous bands of connective tissue in the pelvis that attach to and support the uterus. The growth of the uterus throughout pregnancy causes these ligaments to stretch. This stretching can trigger the following symptoms:

  • pain that radiates from the groin to the hips or upper legs
  • dull aches in the groin or on either side of the stomach
  • spasm-like muscle pain on one or both sides of the stomach
  • sharp, sudden, intensely painful aches that last for just a second

Many women notice that the pain is worse during sudden movements, such as changing positions in bed or going from standing to sitting or vice versa.

Treatment

Round ligament pain does not indicate an issue with the pregnancy, and it usually goes away shortly after a woman gives birth. In the meantime, some strategies that may help alleviate the pain include:

  • bending or flexing the hips before doing anything that tends to cause round ligament pain
  • supporting the uterus with the hand before standing, sitting, or coughing
  • changing position slowly
  • applying a heat pad to the painful area

Vaginal infections

The vagina contains a delicate balance of certain yeasts and bacteria. Vaginal yeast infections occur when there is an overgrowth of yeast inside the vagina. In most cases, there is an overgrowth of a yeast called Candida albicans.

Many factors can cause an overgrowth of yeast in the vagina, including pregnancy. The hormone changes that occur during pregnancy can disrupt the normal pH levels of the vagina, causing yeasts to multiply out of control.

Women who develop a vaginal yeast infection may experience the following symptoms:

  • itching and burning in the vagina and vulva
  • itching and burning of the perineum or anus
  • thick, white vaginal discharge that is usually odorless and resembles cottage cheese
  • pain when urinating
  • pain when having sex
Treatment

Antifungal medications are the usual treatment for vaginal yeast infections. Women who are pregnant or breastfeeding should not take oral antifungal medications. However, it is safe for pregnant women to apply a topical antifungal cream or insert an antifungal suppository into the vagina.

Women who experience the symptoms above during pregnancy should make an appointment with their doctor or midwife. Certain conditions can cause symptoms that mimic those of a vaginal yeast infection. These conditions will require different treatment.

Vaginal dryness

Some women report experiencing vaginal dryness during pregnancy. Vaginal dryness can cause the following symptoms:

  • soreness, itchiness, and general discomfort in and around the vagina
  • pain or discomfort during sex
  • the need to urinate more often than usual
  • recurrent urinary tract infections (UTIs)
Treatment

Vaginal moisturizers can help alleviate vaginal dryness. These are topical medications that a woman can apply to the inside of the vagina.

Water-based sexual lubricants should help alleviate vaginal dryness during sexual activity. However, a woman should not use estrogen-based lubricants during pregnancy.

If vaginal dryness does not get better with home treatment, a woman should talk to her doctor or midwife for further advice.

Pregnant women should discuss any and all aches and pains with their doctor or midwife.

Groin pain is a common symptom during pregnancy, and it often has a relatively benign and treatable cause. Nonetheless, a woman should see a doctor to rule out more serious underlying medical conditions. A doctor can also provide treatment to help manage the pain and any associated symptoms.

Anyone who experiences any of the following symptoms during pregnancy should see a doctor as soon as possible:

  • severe pain
  • worsening pain
  • other aches and pains, such as pain in the upper abdomen

If the following symptoms occur during pregnancy, it is important to call a doctor immediately or go to the nearest emergency room:

  • painful contractions before the 37th week of pregnancy
  • bleeding from the vagina
  • fever or chills
  • chest pain

Groin pain during pregnancy is common. It is usually the result of normal hormonal and other bodily changes that occur throughout the pregnancy. Nonetheless, a woman should report any aches and pains to her doctor or midwife. It is important to receive the correct diagnosis and any necessary treatment.

Vaginal yeast infections are highly treatable, and a woman can expect to make a full recovery following appropriate treatment. Vaginal dryness should also improve with home treatment. However, if either of these conditions persists, a woman should go back to her doctor for further advice.

For most women with SPD or round ligament pain, groin pain goes away shortly after giving birth. However, about 1 in 10 women with SPD experience ongoing pain that requires continued treatment. If the pain persists, a doctor may order diagnostic tests to rule out other underlying health issues, such as hip problems or hypermobility syndrome.

Pain in the pubic region during pregnancy

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The pubic bone is one of the three bones that make up the pelvic bone. Two pubic bones, forming the pubic articulation (symphysis), form the anterior wall of the pelvis. The pubic bone in women with a regular physique has the form of a roller about the thickness of the thumb, which is curved and forms a pubic eminence. This bone hangs in a kind of arch over the entrance to the vagina.

The main cause of pain in the pubic bone is the divergence and increased mobility of the pubic symphysis. To refer to pathological changes in the pubic symphysis of the pelvis during pregnancy and after childbirth, the following terms are used: symphysiopathy, symphysitis, arthropathy of pregnant women, divergence and rupture of the pubic symphysis, dysfunction of the pubic symphysis. The most commonly used terms are "symphysitis" or "symphysiopathy".

So, symphysiopathy is a disease associated with a pronounced softening of the pubic joint under the influence of the hormone relaxin, which is produced during pregnancy. The process of softening the interosseous joints is natural, it helps the child to pass more easily through the bone pelvis during childbirth. The diagnosis of "symphysiopathy" is made when severe pain appears, the pubic joint swells, greatly stretches, becomes mobile, and the pubic bones diverge excessively. One of the striking, characteristic symptoms of this pathology is that it is impossible to raise the leg in the prone position. In addition to acute pain in the pubis, there are difficulties when walking up the stairs, it becomes difficult to turn from side to side on the bed and get up from the sofa, and the gait changes and becomes like a "duck". According to most doctors, the cause of symphysiopathy is a lack of calcium, an increased concentration of the hormone relaxin, and increased physical activity on the bones of the pelvic region. In addition, the development of symphysiopathy can be provoked by a serious sports injury or a fracture of the pelvic bones.

At what stage of pregnancy do they occur?

The disease begins gradually or suddenly during pregnancy, childbirth or after childbirth. Most often, women begin to feel pain in the area of ​​the pubic joint in the third trimester of pregnancy. This is due to the fact that the places of adhesions of the pubic bones, their ligaments and cartilage, soften under the influence of the hormone relaxin. This hormone of pregnancy naturally softens the bony joints, which is necessary to facilitate the passage of the child's bone pelvis and birth canal at the time of childbirth.

Some women begin to complain of pain in the pelvic bones some time after giving birth. This may be the result of traumatic childbirth (imposition of obstetrical forceps, shoulder dystocia, excessive separation of the hips during childbirth, etc.) or physical exertion (lifting a heavy baby stroller up the stairs, prolonged motion sickness in the arms of a well-fed baby, etc. ). It is recommended to limit physical activity, wear an orthopedic bandage, consult a traumatologist. Complaints usually recur after the next pregnancy. In a small proportion of patients, pain persists for a long time.

When can this be considered the norm, and when not?

Obstetricians-gynecologists do not consider a slight soreness of the pubic joint to be a pathology, but if the pain is acute, restricting the movements of the pregnant woman, accompanied by edema, then we can talk about pathology. Pain can be quite strong and especially manifest itself while walking, turning the body to the right and left in a sitting position and even lying down. In this case, you need to urgently consult a doctor and undergo an ultrasound diagnosis (ultrasound) to determine the size of the divergence of the pubic bones. Magnetic resonance imaging (MRI) is also used, which allows assessing the state of the symphysis, the state of the bone tissue, as well as soft tissues.

With ultrasound, the degree of divergence (diastasis) of the pubic bones is determined. The severity of the clinical picture largely depends on the degree of divergence of the pubic bones, and therefore there are three degrees of divergence of the pubic branches: in the first degree - by 6-9 mm, in the second - by 10-20 mm, in the third - more than 20 mm. The severity of the symptoms of the disease varies from mild discomfort to unbearable pain.

How can pain be relieved?

There are some recommendations that will help reduce bone pain during pregnancy, if the cause of its occurrence is the divergence of the pubic bones. Be sure to wear a bandage, especially in later pregnancy. The bandage takes on most of the load, thereby releasing pressure from the pubic joint. Limitation of heavy physical exertion is indicated for any manifestations of pain, lying down more often, walking less and being in a sitting position for no longer than 30-40 minutes. In severe cases, before and sometimes after childbirth, a woman may be shown strict bed rest. Moreover, the bed should not be hard and flat.

Since the appearance of symphysiopathy is associated not only with a large production of the hormone relaxin, but also with a lack of calcium in the body, the expectant mother is prescribed calcium preparations and complex vitamins for pregnant women, which contain all the necessary vitamins and trace elements in the right amount and proportions. There is evidence that pain is reduced during acupuncture and physiotherapy.

In especially severe cases of symphysiopathy, the pregnant woman is hospitalized.

What is the danger of this condition?

The occurrence of symphysiopathy is due to several reasons. This is a lack of calcium in the body of the future mother, and an excess amount of the hormone relaxin, and the individual structural features of the woman's body, and possible hereditary or acquired problems of the musculoskeletal system.

With an unexpressed clinical picture of the disease, with an expansion of the pubic fissure up to 10 mm, normal pelvic sizes, a small fetus, childbirth can be carried out through the birth canal, avoiding the use of physical force, such as the Christeller maneuver. With a pronounced stretching of the pubic symphysis, pain syndrome, especially with anatomical narrowing of the pelvis, a large fetus, there is a danger of rupture of the pubic symphysis, and the method of choice in this case is caesarean section. This is due to the fact that during natural delivery, the bones can disperse even more and the woman subsequently will not be able to walk at all.

Prevention

The body of a healthy woman is able to independently cope with all the difficulties of the pregnancy period. First of all, the expectant mother should include enough foods containing calcium in her diet, as well as take vitamins for pregnant women.

For the prevention of symphysiopathy, the use of a prenatal bandage is recommended, which supports the abdomen and prevents excessive stretching of the ligaments and muscles. Prophylactic antenatal bandage is usually recommended from 25 weeks of gestation, when the abdomen begins to actively grow.

In order to ensure the plasticity of the ligaments and muscles, as well as the flexibility of the joints, special exercises must be done even during the planning of pregnancy. Yoga gives good results.


Is it possible to do laser hair removal during pregnancy

During the period of bearing a child, every woman wants to remain well-groomed and beautiful, so for some, the question becomes relevant - is it possible for pregnant women to do laser hair removal and whether the procedure will harm the unborn child. Laser hair removal during pregnancy is not strictly prohibited, but it can be done only in certain areas and within strictly defined terms. No less important is the proper preparation and subsequent skin care, which allows you to fix the result and prevent the development of undesirable consequences. But before deciding to resort to such a radical procedure, it is advisable to consult with your doctor, as well as a specialist who will perform laser hair removal.

Laser epilation during pregnancy

Laser hair removal is a method of radical hair removal that involves the destruction of hair follicles using laser radiation. During the procedure, laser beams affect only the hair follicle. Melanin, which is responsible for the color of hair and skin, absorbs the laser energy, which, in turn, is transformed into heat that destroys the hair follicle. In this case, the effect is only on the hairs that are in the active phase of growth. For this reason, you will need to undergo a course of laser hair removal, the duration of which depends on the individual characteristics of each woman.

So is it possible to do laser hair removal during pregnancy? Doctors do not have a definite answer to this question. Some argue that the procedure is absolutely safe for the health of the unborn child, while others argue that laser beams can to some extent affect the developing fetus. Laser hair removal for pregnant women is not strictly contraindicated, however, the final decision on the procedure always remains with the woman.

Reasons why you should not do laser hair removal during pregnancy:

  • Change in hormonal background. Hormonal changes during pregnancy often cause intensive hair growth. In these cases, the laser may not be able to cope with the problem, and the desired effect of the procedure cannot be achieved.

  • Decreased pain threshold. During the period of bearing a child, the threshold of pain sensitivity for many women noticeably decreases, so laser hair removal can cause much more discomfort and pain. Such stress can provoke an increase in the tone of the uterus, which is extremely dangerous for the fetus.

Can it hurt the baby

To date, there are no facts that could prove the complete safety of exposure to laser beams on the fetus. Most cosmetologists still advise postponing the procedure and resorting to it after the birth of the child.

Maternal consequences of laser hair removal

It is not completely known how the laser beams affect the fetus, but there is information about the effect of the procedure on the woman herself. Laser hair removal can cause such negative consequences for the expectant mother:

  • burns;

  • edema, hyperemia;

  • the formation of age spots;

  • dehydration, dryness, peeling of the skin;

  • irritation in the form of rashes and redness.

At what stages of pregnancy can laser hair removal be done

Laser hair removal during pregnancy is not strictly prohibited, but it can be done only in certain areas and within strictly defined terms. Before the procedure, it is necessary to consult a specialist and exclude contraindications.

Laser hair removal during early pregnancy

Laser hair removal during early pregnancy (from 1 to 13 weeks) is absolutely contraindicated. It is during this period that the active laying and formation of the vital organs and systems of the unborn child takes place, so any external influence can cause serious disorders and pathologies.

From the second trimester, when the condition of the woman's body stabilizes and the risks of complications for the fetus will be minimal, if necessary, you can resort to laser hair removal.

Which areas can be epilated

Laser hair removal can be done on the following areas of the body:

Laser hair removal bikini during pregnancy is contraindicated. This precaution is due to the fact that this area is in close proximity to the fetus. In addition, the bikini area has very thin and sensitive skin, so epilation here is especially painful and uncomfortable. Severe pain can also lead to uterine hypertonicity, which, in turn, is fraught with serious complications for the unborn child, up to miscarriage or premature birth.

How to prepare for laser hair removal during pregnancy

An integral part of the procedure for removing unwanted hairs with a laser is preparation, the quality of which depends on the results.

Learn more